Friday, September 24, 2010

Battling Maternal Mortality

In anticipation of this week's UN Summit on the Millennium Development Goals (MDGs), several UN entities -- the World Health Organization, UN Children's Fund (UNICEF), UN Population Fund (UNFPA), and the World Bank -- released a study of international trends in maternal mortality between 1990 and 2008. This assessment report, which covers 99.8% of births worldwide, is aimed at achieving the fifth MDG: to reduce the maternal mortality ratio (MMR) by three quarters between 1990 and 2015. While reliable data are hard to collect, particularly in the developing world, the news is modestly positive: The estimated 358,000 maternal deaths in 2008 represent a 34% decline from 1990 levels. While this is not quite the rate of change needed to achieve a 75% drop by 2015, it's certainly a step in the right direction.
The good news? A total of 147 countries experienced a decline in their maternal mortality levels, with enormous drops (from 50 to 75%) in several sub-Saharan African nations. These declines are likely due to improved access to health systems and increased female education. The proportion of deliveries attended by skilled health personnel rose in the developing world, as did the percentage of women receiving prenatal care and the proportion of women using contraception. Notably, East Asia, which experienced the greatest decline in maternal mortality levels, has a contraceptive prevalence rate of 86%, while in sub-Saharan Africa, which faced one of the lowest declines, that rate was only 22%.
The bad news? The developing world suffered an estimated 99% (355,000) of these deaths, with sub-Saharan Africa and South Asia accounting for an estimated 87% (313,000) of global maternal deaths. Just eleven countries from these two regions comprised an estimated 65% of all maternal deaths in 2008, with India accounting for the largest number of deaths (63,000). Of greater concern, 23 countries faced an increase in their MMR over the time period studied. The five countries that fared the worst in terms of increasing maternal mortality rates (Botswana, Lesotho, South Africa, Swaziland, and Zimbabwe) are of course part of the region with the highest HIV rates in the world. In sub-Saharan Africa, 9% of all maternal deaths were due to HIV/AIDS.
The global disparities in maternal mortality are shocking; the MMR in the developing world (290 deaths per 100,000 live births) was over twenty times that of the developed world (14). In four countries -- Afghanistan, Chad, Guinea-Bissau, and Somalia, the MMR was over 1000. In other words, a 15-year old female in sub-Saharan Africa faces a 1 in 31 chance of maternal death over her lifetime, while a girl of the same age in the developed world faces a 1 in 4300 risk. That girl in Afghanistan? A 1 in 11 risk.
Given that many of the causes of maternal deaths in the developing world are relatively easily addressed through basic prenatal and childbirth care (e.g. hemorrhage and hypertension are responsible for more than half of these deaths), it seems that the goal of 75% decline, though ambitious, should be within reach. In recognition of the need for basic improvements in health care for pregnant women, UN Secretary General Ban Ki-moon unveiled on Wednesday his $40 billion Global Strategy for Women's and Children's Health. Here's hoping it can make a difference for that young girl in Afghanistan.
(credit for photo above left)

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